=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558102566
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CAFE ALINEAO QUIROPRACTICA FAMILIAR LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/04/2024
-----------------------------------------------------
Last Update Date | 12/09/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | PR 857 KM 0 H 4 BO. CANOVANILLAS
-----------------------------------------------------
City | CAROLINA
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00987
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-519-9945
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | O21 CALLE GLADIOLA
-----------------------------------------------------
City | CAROLINA
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00985-4233
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-519-9945
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MRS. AMBAR PEREZ RIVERA
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 787-519-9945
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------